目的 探讨锝-亚甲基二膦酸盐联合甲氨蝶呤治疗类风湿关节炎（RA）的效果。方法 采用回顾性、便利抽样研究方法，2016年1月-2018年3月选择在攀枝花市中心医院诊治的RA患者128例作为研究对象，根据治疗方法的不同分为观察组与对照组各64例，对照组给予甲氨蝶呤治疗，观察组给予锝-亚甲基二膦酸盐联合甲氨蝶呤治疗，两组都治疗观察3个月，比较两组的临床疗效，记录两组在治疗期间出现的消化道症状、口腔溃疡、失眠、肝肾功能异常等不良反应情况，记录两组治疗后的关节肿胀数、关节压痛数，比较两组治疗前后的白介素-6（IL-6）及肿瘤坏死因子-α（TNF-α）水平。结果 所有患者都顺利完成治疗，观察组与对照组的治疗总有效率分别为100.0%和89.1%，观察组高于对照组，差异有统计学意义（P<0.05）。观察组与对照组治疗期间的消化道症状、口腔溃疡、失眠、肝肾功能异常等不良反应发生率分别为14.1%和12.5%，两组对比差异无统计学意义。观察组治疗后的关节肿胀数、关节压痛数显著少于对照组，差异有统计学意义（P<0.05）。治疗后两组血清IL-6、TNF-α水平显著低于治疗前，同组治疗前后比较差异有统计学意义（P<0.05），观察组也低于对照组，差异有统计学意义（P<0.05）。结论 锝-亚甲基二膦酸盐联合甲氨蝶呤治疗RA能抑制炎症因子的释放，能改善患者的关节功能障碍，提高治疗疗效，且不会增加不良反应的发生，有很好的应用价值。

Objective To explore the effect of technetium methylenediphosphonate combined with methotrexate in the treatment of rheumatoid arthritis (RA). Methods From January 2016 to March 2018, used a retrospective and convenient sampling method, 128 patients with RA were selected and were divided into the study group and the control group of 64 cases in each groups accorded to the different treatment methods. The control group were treated with methotrexate, and the observation group were given technetium methylenediphosphonate combined with methotrexate treatment. The two groups were treated for 4 weeks, and the prognosis were recorded. Results All patients completed the treatment successfully, the total effective rates of the study group and the control group were 100.0% and 89.1% respectively, and the study group were higher than that of the control group (P<0.05). The incidence of alimentary tract symptoms, oral ulcers, insomnia and abnormal liver and kidney function in the study group and the control group were 14.1% and 12.5% respectively during the treatment, and there were no significant difference compared between the two groups. The number of joint swelling and joint tenderness after treatment in the study group were significantly less than those in the control group (P<0.05). After treatment, serum IL-6 and TNF-α levels of the two groups were significantly lower than those before treatment (P<0.05), and the study group were also lower than that of the control group (P<0.05). Conclusion The technetium methylenediphosphonate combined with methotrexate in treatment of RA can inhibit the release of inflammatory factors, improve the patients' joint dysfunction, improve the therapeutic effect, and will not increase the occurrence of adverse reactions.

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